Gliederung

In secondary prevention, many patients with coronary heart disease exceed the recommended limits for blood pressure (140/90 mmHg) and LDL (100 mg/dl). Up to now, there is insufficient data as to what extent these limits are attained by routine rehabilitation programs.

Method

During 2000/ 2001, the ROG study (register of guideline-based therapy) enrolled 47.321 consecutive patients (median age 63.4 years, 33.6% female) who had experienced an acute coronary syndrom and subsequently took part in an inpatient rehabilitation programm. Blood pressure values (RR) and LDL were recorded at admission and discharge. The proportion of patients who exceeded the recommended target limits were calculated. The blood pressure and lipid reduction were studied in relationship to admission levels by fitting LOWESS regression lines to scattergrams, supplemented by QQ plots in order to keep control over regression towards the mean phenomena that may be mistaken as treatment effects.

Results

Syst. and diast. RR reduction was 30% of the excess, on average, but varied substantially between patients. Syst./diast. RR values of 140/90 mmHg were exceeded by 44.6%/23.7% of patients at the beginning of rehabilitation, but by only 16.9%/5.7% at discharge. 47.9% of patients were included with at least one of the initial RR measurements above limit. This percentage reduced to 19.4% to discharge, i.e. the treatment was effective for 69.2% of the patients to be treated. Substantial mean LDL reductions could be observed above initial levels of 110 mg/dl. Up to 150 mg/dl average reduction is approximately 35% of excess. Initially, 80.5% of patients ecxeeded the limit of 100 mg/dl, reduced to 45.1% at discharge.

Conclusion

At the end of the rehabilitation program, blood pressure and LDL levels of more than 2/3 of patients had been reduced below the recommended target values set by secondary prevention guidelines. Therefore, cardiac rehabilitation is an effective setting.